肛瘘切开术联合袋形缝合术治疗低位肛瘘的临床观察  

Clinical observation on treatment of low anal fistula by anal fistulotomy combined with marsupialization

作　　者：金杰 施捷 钱晶晶 蔡娇娇 JIN Jie;SHI Jie;QIAN Jingjing;CAI Jiaojiao(Department of Traditional Chinese Medicine Surgery,Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 202150,China)

机构地区：[1]上海交通大学医学院附属新华医院崇明分院中医外科,上海202150

出　　处：《上海中医药杂志》2022年第8期59-62,共4页Shanghai Journal of Traditional Chinese Medicine

基　　金：上海市卫健委进一步加快中医药事业发展三年行动计划项目(ZY2018-2020-FWTX-7001)

摘　　要：目的观察肛瘘切开术联合袋形缝合术治疗低位肛瘘的临床疗效。方法将80例低位肛瘘患者随机分为治疗组、对照组,每组40例。对照组给予单纯肛瘘切开术治疗,治疗组给予肛瘘切开术联合袋形缝合术治疗。观察临床疗效,比较两组手术时长、手术创面面积、术后疼痛视觉模拟评分(VAS)、术后创面渗出量、创面愈合时间、愈合时疤痕面积、术后肛门失禁Wexner评分。结果①经治疗,两组患者均达到痊愈标准,两组临床疗效比较,差异无统计学意义(P>0.05)。②治疗组手术时长大于对照组、平均疼痛VAS评分少于对照组、平均创面渗出量少于对照组,差异有统计学意义(P<0.05)。③治疗组手术创面面积、愈合时疤痕面积小于对照组,创面愈合时间短于对照组,差异有统计学意义(P<0.05)。④两组术后肛门失禁Wexner评分比较,差异无统计学意义(P>0.05)。结论与单纯肛瘘切开术相比,肛瘘切开术联合袋形缝合术能有效治疗低位肛瘘,具有疗程短、术后并发症轻等优势,且不会增加肛门失禁风险,安全性良好。Objective To observe the clinical effect of fistulotomy combined with marsupialization on the treatment of low anal fistula.Methods Eighty patients with low anal fistula were randomly divided into a treatment group(n=40)and a control group(n=40).The control group was treated with fistulotomy alone,and the treatment group was treated with fistulotomy and marsupialization.The clinical effect was observed,the duration of surgery,the area of surgical wound,the visual analogue scale(VAS)score of postoperative pain,the amount of postoperative wound exudation,the time taken for wound healing,the scar area at healing,and the Wexner score of postoperative anal incontinence were compared between the two groups.Results①After treatment,patients in both groups were cured clinically,and there was no statistically significant difference in the clinical effect between the two groups(P>0.05).②The treatment group took longer time to operate than the control group,the average pain VAS score of the treatment group was lower than that of the control group,the average amount of wound exudation of the treatment group was less than that of the control group,and these differences were statistically significant(P<0.05).③The surgical wound area and scar area at healing in the treatment group were smaller than those in the control group,the time taken for wound healing was shorter than that in the control group,and these differences were statistically significant(P<0.05).④The difference in the Wexner score of postoperative anal incontinence between the two groups was not statistically significant(P>0.05).Conclusion Fistulotomy combined with marsupialization can effectively and safely treat low anal fistulas with a shorter treatment course and milder postoperative complications than fistulotomy alone,without increasing the risk of anal incontinence.

关 键 词：低位肛瘘 肛瘘切开术 袋形缝合术 疼痛 创面愈合 临床试验 

分 类 号：R657.16[医药卫生—外科学]